Suture delivery device for suturing tissue

ABSTRACT

Systems are provided for delivering a suture to close a surgical opening. An elongated deployment member may have at its distal end a retracted counterforce member. The counterforce member may be inserted into the surgical opening and deployed to resist being withdrawn from the opening. A compression member may be slid down the elongated member to compress the tissue to be sutured against the counterforce member. Suture passers loaded with suture ends may be passed through needle tubes within the elongated member to emerge from the elongated member and pierce the tissue to be sutured, then deposit the suture ends with a suture catcher. The suture passers may be withdrawn, leaving the suture ends. The suture catcher may be retracted, retaining the suture ends and the device—elongated member, retracted suture catcher, and retained suture end—may be withdrawn from the surgical opening. The suture may then be completed.

RELATED APPLICATIONS

This application claims priority to and benefit of U.S. ProvisionalPatent Application Ser. No. 61/937,089, filed Feb. 7, 2014, the contentsof which are incorporated by reference in its entirety.

FIELD OF THE PRESENT DISCLOSURE

The present disclosure relates generally to techniques and devices forthe closing of small incisions in a patient's body. For example, thepresent disclosure relates to systems, devices, and methods for theclosure of laparoscopic port sites, which is needed following a varietyof minimally invasive surgical procedures, e.g., a cholecystectomy, anappendectomy, or a bariatric surgery.

BACKGROUND

Laparoscopic surgery is a type of minimally invasive surgery. It is asubstitute for traditional “open” surgeries and provides the benefits ofminimizing post-operative pain, decreasing hospital stays and periods ofdisability, and reducing costs for both hospitals and patients.

Over 7.5 million laparoscopic surgeries are performed worldwide eachyear in the areas of, e.g., cholecystectomy, appendectomy, bariatricsurgeries, gynecological surgeries, and urological surgeries. However,because of the incidence rate of port-site herniation for thelaparoscopic surgeries, port-site closure is preferred for fascialincisions greater than or equal to 10 mm. Port-site closure caneffectively reduce the rate of herniation, reducing the need for herniarepair surgery, which has estimated costs of between US$6,000-US$10,000per procedure and three-week recovery times. Approximately 70% of thelaparoscopic procedures performed have 10 mm or larger port-sites.

To ameliorate these problems, techniques for suturing the port site havebeen developed. Despite the benefits associated with the use of suturedelivering devices, a number of challenges exist. Devices for port-siteclosure can rotate, tilt, and slide downward vertically in the woundtrack or incision during the insertion of a suture needle. If the devicerotates, the suture will be deployed at less that the ideal 180 degreeplacement across the wound. If the device slides vertically during theinsertion, the tissue bite of desired muscle/fascia layer is reduced fordevices that use the peritoneum as a reference point for needle entryinto the muscle/fascia layers. That is, if such a device is not engagedagainst the peritoneum due to downward sliding, the needle entry pointinto muscle/fascia layers will be lower than the intended position andreduce tissue bite. It is also desirable to provide a device configuredto deploy the needles in a reproducible manner to minimize the amount ofskill required from the operator. Accordingly, this disclosure isdirected to systems and methods for wound closure that provide these andother desired characteristics.

SUMMARY

This disclosure includes a suture delivery device for suturing tissue.In an embodiment, the delivery device includes an elongated deploymentmember. Towards the distal end of the elongated deployment member, acounterforce member is configured to transition between a retractedconfiguration that facilitates the counterforce member entering anincision and a deployed configuration that resists extracting thecounterforce member from an incision. Towards the proximal end of theelongated deployment member, a compression member is configured toresist entering an incision. The compression member and the counterforcemember transition between a compressed configuration and an uncompressedconfiguration. In the compressed configuration, tissue may be sandwichedbetween the compression member and the counterforce member to stabilizethe device. A suture catcher disposed towards the distal end of theelongated deployment member is configured to transition between aretracted configuration that facilitates the suture catcher entering anincision and a deployed configuration that facilitates catching asuture. A first needle track is associated with the elongated deploymentmember and is oriented towards a first area of the suture catcher whenin the deployed configuration. A second needle track is also associatedwith the elongated deployment member and is oriented towards a secondarea of the suture catcher when in the deployed configuration. The firstarea of the suture catcher when in the deployed configuration and thesecond area of the suture catcher when in the deployed configuration aresituated on the suture catcher to allow their placement on oppositesides of an incision. The first and second needle tracks may passthrough the elongated deployment member.

In an embodiment, the compression member is configured to resistentering an incision, and is position-able along the elongateddeployment member to transition between a compressed configuration andan uncompressed configuration.

In an embodiment, the compression member is configured to resistentering an incision, and is position-able along the elongateddeployment member to transition between a compressed configuration andan uncompressed configuration. This embodiment also includes acounterforce member that is configured to transition between a retractedconfiguration that facilitates the counterforce member entering anincision and a deployed configuration that resists extracting thecounterforce member from an incision. In this embodiment, thecounterforce member also includes a suture catcher.

BRIEF DESCRIPTION OF THE DRAWINGS

Further features and advantages will become apparent from the followingand more particular description of the preferred embodiments of thedisclosure, as illustrated in the accompanying drawings, and in whichlike referenced characters generally refer to the same parts or elementsthroughout the views, and in which:

FIGS. 1A and 1B depict a side view of an embodiment of a suture deliverydevice handle;

FIGS. 2A-2C depict perspective views of an embodiment of a suturepasser;

FIG. 3 depicts a perspective view of an embodiment of a suture deliverydevice handle with suture passer inserted;

FIGS. 4A-4C depict an embodiment of a suture delivery device with asuture escape slot;

FIGS. 5A and 5B depict cross-sections of an embodiment of a suturedelivery device with telescoping needle tracks;

FIGS. 6A-6C depict an embodiment of a suture catcher;

FIG. 7 depicts a cross-sectional perspective of a section of anembodiment of a suture delivery device;

FIGS. 8A-8G depict stages in the use of an embodiment of a suturedelivery device handle and suture passer;

FIGS. 9A and 9B depict a side view of stages of retracting an embodimentof a suture catcher;

FIGS. 10A and 10B depict an embodiment for automatically releasing asuture;

FIG. 11 depicts an embodiment of a suture catcher in cross-section;

FIGS. 12A and 12B depict embodiments of attaching membranes to struts;

FIGS. 13A-13D depict embodiments of attaching membranes to struts;

FIGS. 14A and 14B depict an embodiment for attaching a membrane to astrut;

FIGS. 15A and 15B depict an embodiment for attaching a membrane to astrut;

FIG. 16 depicts a perspective view of an embodiment for attaching amembrane to a strut;

FIG. 17 depicts an embodiment for managing membrane sag;

FIGS. 18A and 18B depict an embodiment of a suture delivery devicehandle;

FIGS. 19A and 19B depict an embodiment of a suture delivery devicehandle;

FIGS. 20A-20C depict an embodiment of a suture catcher;

FIGS. 21A-21E depict embodiments of a multi-use suture catcher;

FIGS. 22A-22D depict embodiments of a suture passer tip;

FIGS. 23A and 23B depict an embodiment of a suture delivery device;

FIGS. 24A-24E depict embodiments of a suture catcher;

FIGS. 25A and 25B depict an embodiment of a suture catcher;

FIG. 26 depicts an embodiment of a suture catcher; and

FIG. 27 depicts an embodiment of a suture catcher.

DETAILED DESCRIPTION

At the outset, it is to be understood that this disclosure is notlimited to particularly exemplified materials, architectures, routines,methods or structures as such may vary. Thus, although a number of suchoptions, similar or equivalent to those described herein, can be used inthe practice or embodiments of this disclosure, the preferred materialsand methods are described herein.

It is also to be understood that the terminology used herein is for thepurpose of describing particular embodiments of this disclosure only andis not intended to be limiting.

The detailed description set forth below in connection with the appendeddrawings is intended as a description of exemplary embodiments of thepresent disclosure and is not intended to represent the only exemplaryembodiments in which the present disclosure can be practiced. The term“exemplary” used throughout this description means “serving as anexample, instance, or illustration,” and should not necessarily beconstrued as preferred or advantageous over other exemplary embodiments.The detailed description includes specific details for the purpose ofproviding a thorough understanding of the exemplary embodiments of thespecification. It will be apparent to those skilled in the art that theexemplary embodiments of the specification may be practiced withoutthese specific details. In some instances, well known structures anddevices are shown in block diagram form in order to avoid obscuring thenovelty of the exemplary embodiments presented herein.

For purposes of convenience and clarity only, directional terms, such astop, bottom, left, right, up, down, over, above, below, beneath, rear,back, and front, may be used with respect to the accompanying drawings.These and similar directional terms should not be construed to limit thescope of the disclosure in any manner.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one having ordinaryskill in the art to which the disclosure pertains. For example, the term“suturing” includes drawing two surfaces or edges together with aflexible material to close a puncture, opening, or other wound, whereinthe suture is a material that may be synthetic or natural, such as apolymer, gut, metallic wire or other suitable equivalents.

As used in this specification and the appended claims, the singularforms “a, “an,” and “the” include plural referents unless the contentclearly dictates otherwise.

Embodiments within describe a suture delivery device that may beinserted into the same opening used to perform a surgical procedure,such as laparoscopic surgery. The suture delivery device decreases thepotential for tilting, rotating, or sliding relative to the opening bycompressing the surrounding tissue, thereby stabilizing the devicewithin the opening. Thus stabilized, the suture delivery device is ableto improve tissue bite by reliably directing a suture to apre-determined tissue area or layer. The suture delivery device may beused to orient one or more suture passers, which pass through the bodyof the delivery device to pierce through the port-site tissue andrelease the suture after the piercing. The suture delivery devicecaptures the sutures and, upon withdrawing the delivery device, thesuture ends are drawn back through the opening so that the suture may besecured and the opening closed. Embodiments are easy to use, which isimportant for a tissue closure device, which may be a last step in long,tiring surgical procedure.

A suture delivery device (or “wound closure device,” or “trocar woundclosure device” (TWC)) generally has two parts: a handle 100 (FIGS. 1A,1B) and a suture passer (FIGS. 2A-2C). FIGS. 1A and 1B depict twoconfigurations of an embodiment of a suture delivery device handle 100.The configuration in FIG. 1A is used when the device is inserted into anopening. In FIG. 1A, handle 100 is in an uncompressed configuration.FIG. 1A depicts handle 100 with a shaft 105, a catcher 110 (includingcatcher elements 112, 114), a slider 115, needle tracks 150, 155, and asuture exit slit 160. Shaft 105 is an elongated deployment memberequipped with a ridged track 120. Slider 115 is a compression memberthat may be moved along shaft 105 toward a distal end 135 and fixed inposition by engaging track 120. Anti-rotation bumps, not shown, alongwith track 120 prevent slider 115 from rotating relative to needletracks 150, 155 (FIG. 1B). Slider button 125 may be used to engage ordisengage track 120. Catcher 110, shown closed, is a counterforce memberwhen deployed and may include teeth 140, which may close about and graspa suture. Control button 130, shown depressed, moves a control rod 145(FIG. 1B), which opens (or deploys) or closes catcher 110 by movingstruts 165, 170. With catcher 110 closed, distal end 135, catcher 110,and shaft 105 may be inserted into a surgical opening until catcher 110is through the opening, at which point catcher 110 may be deployed asshown in FIG. 1B.

In FIG. 1B, handle 100 is in a compressed configuration, with controlbutton 130 shown released, control rod 145 visible, catcher 110deployed, and slider 115 moved distally. To deploy catcher 110, controlbutton 130 is released, to move control rod 145 proximally (i.e., towardcontrol button 130, or “up” in this view), causing struts 165, 170 todeploy catcher 110. To move slider 115 either proximally or distally,slider button 125 is used to disengage slider 115 from track 120 andthen slider 115 may then be moved. Optionally, slider 115 may ratchetdistally along shaft 105, with slider button 125 used to disengageslider 115 from track 120 and move slider 115 proximally (see FIG. 7).

The configuration in FIG. 1B may compress tissue between slider 115 andcatcher 110. For example, the fascia, muscle and peritoneum layer of anabdominal wall may be compressed between slider 115 and catcher 110,with the peritoneum nearest to catcher 110. As shown deployed, catcher110 would resist being pulled through the opening in the abdominal wall.Thus, in this embodiment, catcher 110 is a counterforce member. In otherembodiments, a counterforce may be applied by elements that lack suturecatching capabilities. Similarly, in other embodiments, suture-catchingcapability may be supplied by elements that lack counterforcecapability.

In this configuration, with tissue compressed between slider 115 andcatcher 110, handle 100 is stabilized relative to the compressed tissue,reducing the potential for rotation, sliding, or tilting. Furthermore,with handle 100 stabilized, needle tracks 150, 155 are also stabilizedrelative to the surrounding tissue, which is the tissue to be sutured.This provides for the optimal placement of sutures and for deployingsutures in a reproducible manner, both of which work to ensure propertissue bite and minimize the amount of skill required from an operator.

FIGS. 2A-2C depict an embodiment of a suture passer 200. Suture passer200 is used to grasp a suture end and pass the suture through a needletrack, e.g., needle track 150, to position the suture so it may becaught by catcher 110. Suture passer 200 includes a hook 205 at a distalend, a needle tube 210, a shaft 215, a trigger 220, and a needle button225. Hook 205 is at the distal end of shaft 215. Needle tube 210 has apoint at the distal end and may move relative to shaft 215 to cover oruncover hook 205. Hook 205 is configured to accept a suture 230 (seeFIG. 2B) and, when covered by needle tube 210, retain the suture (seeFIG. 2C). Hook 205 may have a blunt tip—a point not being necessarywhile loading the suture. Hook 205 may also have a ramp 235 that allowsa suture to slide off when hook 205 is uncovered. In FIG. 2A, needlebutton 225 is shown extended (not pressed) and hook 205 is shownuncovered. Needle button 225, when pressed, may extend needle tube 210over hook 205 to retain a suture. Trigger 220, when pressed, may resultin needle tube uncovering hook 205 to release a suture. Needle tube 210,shaft 215, hook 205, and trigger 220 are configured to fit within needletracks 150, 155 and to deliver and release a suture in a desiredlocation relative to a deployed catcher 110.

FIGS. 2B and 2C generally depict the loading of suture passer 200.Suture passer 200 has two states that are controlled by needle button225 and trigger 220. In the initial “off” state shaft 215 and hook 205protrude from the needle tube 210. Hook 205 is used to receive thesuture in this configuration. That is, suture 230 may be positioned tobe grabbed by hook 205. To transition to an “on” state, a user pressesneedle button 225, which causes needle tube 210 to extend to coversuture 230 and hook 205. Thus, shaft 215, hook 205, and needle tube 210cooperate to retain or grasp suture 230. To return to the “off” state,trigger 220 may be activated by pressing it in the proximal direction.Pressing trigger 220 may thereby release suture 230.

FIG. 3 depicts a suture delivery device 300. In FIG. 3 suture passer 200inserted into needle track 150 of handle 100. Handle 100 is in acompressed configuration with catcher 100 deployed and slider 115 moveddistally. Needle button 225 is shown depressed, with needle tube 210covering hook 205 (not shown). The distal tip of needle tube 210 is neara membrane 302. Membrane 302 extends between catcher elements 114 and314. Membrane 305 extends between catcher elements 112 and 312.

As shown in FIG. 3, needle track 150 has oriented suture passer 200 topoint to an area between catcher elements 114 and 314 of deployedcatcher 110. In this embodiment, catcher 110 has been provisioned withmembrane 302 in that area. Membrane 302 is added to improve the abilityof catcher 110 to catch a suture. If suture passer 200 is insertedfurther into needle track 150 the sharp point of needle tube 210 wouldpierce membrane 302, carrying a suture (not shown) with it. Furtherinsertion would cause trigger 220 to touch the opening of needle track150. Still further insertion would cause trigger 220 to actuate andcause needle tube 210 to retract, exposing hook 205 and releasing thesuture (not shown). At that point, suture passer 200 could be withdrawnfrom needle track 150. Withdrawing suture passer 200 from the needletrack would also withdraw it from membrane 302. But the suture, havingbeen released from hook 205, would be retained within membrane 302.Then, if catcher 110 is then retracted, membrane 302 is also retracted,bringing the suture with it to be grasped by catcher elements 114, 314.This is described further with respect to FIGS. 9A and 9B.

FIGS. 4A-4C depict an embodiment of a handle 100 providing automaticsuture release. When two ends of a single suture are delivered into asurgical opening and retained at the distal end of the suture deliverdevice, the portion of the suture near the proximal end forms a loop.The loop could become entangled with the device during device retrieval.Existing closure devices allow for the operator to manually disengagethe suture from the device. The embodiment of FIGS. 4A-4C uses aninternal suture escape slot 400 that facilitates the automatic releaseof suture 415. Suture escape slot 400 connects needle tracks 150, 155throughout their length, providing a slot for a suture 415 to passthrough handle 100 and out suture exit slot 160. In FIG. 4A, suturepasser 200 is inserted in needle track 155 and extends from shaft 105exposing needle tube 210. Needle tube 210 is shown after piercingmembrane 305. A suture tip 410 of suture 415 is shown also passingthrough membrane 305, having been carried through by the tip of suturepasser 200. Control button 130 is shown extended. Thus, needle tube 210is not covering hook 205 and suture end 410 is released from suturepasser 200 (though the needle tip is obscured in FIG. 4A by membrane305). Needle track 150 shows suture 415 after suture end 405 has beenpassed through membrane 302, released, and suture passer 200 withdrawn.As shown in FIG. 4A, both suture ends 405, 410 are retained by membranes302, 305. From suture end 405, suture 415 passes through and out ofneedle track 150, loops over handle 100, and, accompanied by suturepasser 200, enters needle track 155. In FIGS. 4A-4C, slider 115 is notshown to more clearly explain the internal suture escape path.

In FIG. 4B, suture passer 200 has been withdrawn from needle track 155and catcher 110 has been retracted, grasping suture ends 405, 410.Handle 100 may be withdrawn from a surgical opening in thisconfiguration, pulling suture ends 405, and 410 with it. Suture 415makes a loop between a needle track exit 152 and catcher 110. Suture 415also makes a loop between a needle track exit 157 and catcher 110. Theseloops represent portions of suture 415 that have passed through thetissue to be sutured. Thus, when handle 100 is removed from the surgicalopening, pulling suture ends 410, 415 with it, the sections of suture415 looped through the tissue will pull the remainder of suture 415 downthrough suture escape slot 400 (as shown, dotted). In FIG. 4C, suture415 has passed completely through suture escape slot 400 and out sutureexit slot 160.

Thus, with reference to FIGS. 1-4, embodiments of handle 100 of suturedelivery device 300 may include needle track elements, e.g., needletracks 150, 155, and a suture retention element, e.g., catcher 110. Theneedle track elements may extend from the proximal end towards distalend of handle 100 and may include an auto suture release mechanism,e.g., suture escape slot 400. The suture retention element may bedisposed at or near the distal end of handle 100. The suture deliverydevice may also have a compressive element, e.g., slider 115.

The needle track elements may provide defined trajectories for needles(e.g., suture passer 200) inserted through the handle (e.g., handle100), beginning near the proximal end and exiting near the distal end.For example, with the handle inserted into a surgical opening, a needlemay enter the proximal end of a needle track element (e.g., needle track150) above the skin, travel through the needle track in the device, andexit at the distal end to penetrate through tissues layers (such asfascia, muscle, and peritoneum) at defined position and angle relativeto the handle. The needle trajectory may be completely enclosed by thehandle between entry and exit. The needle track element may be coupledwith an auto suture release mechanism (described with reference to FIGS.4A-4C) whereby the suture loop (or main section of the suture, excludingthe suture ends) is not retained at the device's distal end and mayslide out, without user intervention, from the needle track as thehandle is withdrawn from the surgical opening.

The suture retention element (e.g., catcher 110) may comprise a frame(e.g., catcher elements 112, 114, 312, 314) and suture capturesurface(s) (e.g., membranes 302, 305) or a frame only. The sutureretention element may be provided with features to improve its grip onthe suture (e.g., teeth 140). The suture retention element frame mayhave multiple struts and may have various geometries (e.g., flat,lantern, molly, umbrella, etc.). The suture retention element frame maydefine a target area and may provide a counterforce to the compressiveforce of the compressive element, sandwiching the tissue in between.This counterforce may be against, for example, the peritoneum. Thesuture retention element may also provide support to an optional suturecapture surface during needle insertion. The suture retention elementmay be inserted through the tissue opening in a low profile or retractedstate and deployed to its expanded state after passing through tissuelayers to the intended position, which may be, for example, inside theperitoneal cavity. The suture capture surface may be coupled to thestruts of the frame, and may be in a folded configuration during deviceinsertion as well as during device withdrawal.

A needle (e.g., suture passer 200) carrying a suture may be introducedinto a needle track element (e.g., needle track 150), guided topenetrate through tissue layers (e.g., past the peritoneum), andinserted into the catcher (e.g., positioned between catcher elements112, 312, or inserted into membrane 305). The design of the distal tipof the needle may allow the suture to be disengaged from the needle(e.g., hook 205 may have a ramp 235 that allows suture 230 to slide off,rather than a true “hook”). In some embodiments, the needle may betriggered to release the suture from its tip when the needle is insertedto an intended position.

In embodiments, the needle tip design (e.g., ramp 235) may allow thesuture to disengage from the needle. In embodiments with a capturesurface (e.g., membranes 302, 305), the surface itself may have aproperty or a design that enhances the capture and retention of sutureby the surface, which assists disengaging the suture from the needle.

The device may be withdrawn from the surgical opening (e.g., a trocarwound) while retaining the captured suture ends at the distal end ofdevice (e.g., in the catcher).

In an embodiment, the membrane is essentially enclosed by the catcherframe during the insertion and withdrawal of the catcher through tissuelayers. In embodiments, the suture ends may be captured in the membraneas well as held between struts of the closed catcher frame. In anembodiment in which the suture retention element includes a frame, thesuture ends may be retained by mechanical clamping between struts of theclosed frame during device retrieval.

The suture delivery device may also have a compressive element, e.g.,slider 115, that is movable along the device shaft to adapt for varyinganatomy. The compressive element may be placed in a position thatsandwiches tissue against a counterforce member (e.g., catcher 110). Forexample, the tissue may be the layers of the abdominal wall, thecounterforce member may be positioned in the abdominal cavity againstthe peritoneum, and the compressive element may be against the surfaceof the skin. The compressive element thereby stabilizes the tissue whileadapting to varying anatomy. In some embodiments, the compressiveelement may be linked to a counterforce member deployment mechanism sothat movement of the compressive element causes the counterforce memberto deploy and retract.

FIGS. 5A and 5B show cross-sections of an embodiment of handle 100 withtelescoping needle tracks 153, 158. In FIG. 5A, handle 100 is in anuncompressed configuration with slider 115 extended proximally, awayfrom catcher 110. For simplicity, and because telescoping needle tracks153, 158 are similar, only telescoping needle track 153 will bedescribed. Telescoping needle track 153 includes a pair of tubes 505,510 configured to telescope, tube 510 within tube 505. In an embodiment(not shown), tube 505 moves within tube 510, so that a suture passerwould avoid hitting the end of tube 510 when inserted. In FIGS. 5A and5B, tube 505 is anchored at the non-telescoping end to slider 115. Tube510 is anchored at the non-telescoping end to shaft 105. The anchorattachments allow angular motion between the tube and anchor point. InFIG. 5B, handle 100 is in a compressed configuration with slider 115moved distally, toward catcher 110. With that motion, telescoping needletracks 153, 158 have shortened in length and changed the angle at whichthey exit handle 100. Still, telescoping needle tracks 153, 158 areoriented to direct a suture passer towards catcher 110. In the movementof slider 115 from the uncompressed to compressed configuration,telescoping needle track 153 has swept out a volume within shaft 105bounded by an upper limit 520, a lower limit 525, and needle track exit152. In this embodiment, handle 100, shaft 105, and slider 115 areconfigured to permit this motion of telescoping needle tracks 153, 158.

In a method of using an embodiment, handle 100 is initially in theuncompressed and retracted configuration. In a first step, handle 100 isinserted into the trocar wound. In a next step, control button 130 ispressed to open the catcher 110. In a next step, handle 100 is pulled upagainst the tissue until the catcher 110 is in contact with theperitoneum. In a next step, slider 115 is pushed down to sandwich theabdomen wall against the catcher 110. The handle is then stabilizedwithin the tissue to be sutured. In a next step, one end of suture 230is loaded onto hook 205 and needle button 225 is pressed. In a nextstep, suture passer 200 is inserted into a needle track and trigger 220is activated, releasing suture 230. In a next step, suture passer 200 iswithdrawn from handle 100. In a next step, a second end of suture 230(or the end of a different suture) is loaded onto hook 205 and theprevious two suture-passing steps repeated in a different needle track.Handle 100 may now be withdrawn, taking with it the suture endsaccording to the following steps. In a next step, control button 130 ispressed to capture the suture ends with catcher 110 (the suture ends mayalso have been retained by optional membranes 302, 305). In a next step,handle 100 is withdrawn from the surgical opening, bringing with it thesuture ends. The suture ends are then removed from handle 100 andknotted.

FIGS. 6A-6C depict an embodiment of a suture catcher 110 in retracted,partially deployed, and fully deployed configurations, respectively. InFIG. 6A, suture catcher 110 has hinge joints 705, 710, 715, struts 165,170 and catcher elements 112, 114. Joints 705, 710, 715 may be amechanical, or a living hinge, or a combination. In FIG. 6B, catcher 110has been expanded to a partially deployed status by using control rod145 to urge struts 165, 170 against catcher elements 112, 114. Catcherelements 312, 314 have been similarly deployed. In FIG. 6C, catcher 110has been fully deployed using control rod 145. FIG. 6C also showsoptional membranes 302, 305 attached to catcher elements 112, 114.Control button 130 (FIGS. 1 and 3) may be connected to control rod 145and used to activate control rod 145.

FIG. 7 depicts in cross-section a section of an embodiment of handle100. In the embodiment of FIG. 7, slider 115 may move easily toward thedistal direction, but not toward the proximal direction, using a ratchet805 and rack 810. Thus, slider 115 may easily move toward a compressedconfiguration, but not an uncompressed configuration. In the embodiment,pushing slider button 125 releases ratchet 805, allowing slider 115 tomove proximally. Rack 810 may include a lower limit (not shown) thatprevents the slider from moving too far in the compressive direction. Inan embodiment, a friction pad (not shown) is used between slider 115 andshaft 105. The shape of the friction pad is designed to modulate pushingfriction in two directions.

FIGS. 8A-8G depict an embodiment in the various stages of deploying asuture. FIG. 8A is a perspective view of a loaded suture passer 200inserted into needle track 150. In FIG. 8A, catcher 110 is in thedeployed configuration. Needle tube 210, grasping suture end 405, hasexited needle track 150, but has not yet penetrated membrane 302. InFIG. 8B, suture passer 200 has been further inserted into needle track150 so that needle tube 210 has penetrated membrane 302 (not shown),taking suture end 405 through membrane 302 as well. In FIG. 8B, needletube 210 is shown piercing three layers of tissue 902, 904, 906. Thus,eventually, the bite of suture 230 will include those layers. In FIG.8C, suture passer 200 has been inserted still further into needle track150, causing trigger 220 to be depressed, which, as described withreference to FIGS. 2A-2C, resets needle tube 210 to “off” and releasessuture 230 from suture passer 200. FIG. 8D depicts a close-up of thedevice from FIG. 8C. In FIG. 8D, needle tube 210 and suture end 405 havepenetrated membrane 302. Suture end 405 is seen to be free of hook 205and needle tube 210. In FIG. 8E, suture passer 200 has been withdrawnfrom needle track 150. Suture end 405 has been retained—held by theretentive squeezing properties of membrane 302. FIG. 8F depicts theprocess being repeated with suture end 410, needle track 155, andmembrane 305 (not shown). FIG. 8F also depicts the bite of the suturewith suture ends 405, 410 each passing through tissue layers 902, 904,906. And FIG. 8G depicts handle 100 after suture passer 200 has deployedsuture ends 405, 410 into membranes 302, 305, respectively, and beenwithdrawn.

FIGS. 9A and 9B depict a handle 100 at different stages of capturing thesuture ends. After suture ends 405, 410 are deployed onto membranes 302,305 (as in FIG. 8G), control button 130 is pressed, moving control rod145 distally to close catcher 110. FIG. 9A depicts handle 100approximately mid-way through the process of capturing suture ends. Ascontrol button 130 is depressed, membranes 302, 305 fold between catcherelements 114, 314 (FIG. 3) and 112, 312 (FIG. 3), respectively, bringingsuture ends 405, 410 with them. FIG. 9B depicts catcher 110 in theretracted configuration. Control button 130 has been fully depressed. Inthis configuration catcher 110 no longer provides a counterforce to thecompressive forces of slider 115, which is still in the compressiveposition. That is, catcher 110 no longer presents a flat surface totissue layers 902, 904, 906 and may be easily withdrawn. In the fullyretracted position, elements 114, 314 and 112, 312 clamp respectivesuture ends 405, 410. Optional teeth 140, which may also be betweencatcher elements 112, 312 and 114, 314 (see FIGS. 6C, 8D) improve thehold on suture ends 405, 410.

FIGS. 10A and 10B depict an embodiment of a handle 100 automaticallyreleasing the suture after catcher 110 has been fully retracted. In FIG.10A, suture 230 has been deployed onto layers 902, 904, 906 of, forexample, the abdomen wall with suture ends 405, 410 captured by catcher110 on handle 100. Handle 100 has been pulled from surgical opening1100, carrying with it suture ends 405, 410 and pulling more of suture230 into surgical opening 1100 and through tissue layers 902, 904, 906.This has caused the loop of suture 230 to enter suture escape slot 400(see FIGS. 4A-C). In FIG. 10B, continued pulling on handle 110 hascaused the remainder of suture 230 to pass through suture escape slot400 and out suture exit slot 160.

A method of using an embodiment to close a wound begins with the suturedelivery device handle in the uncompressed and retracted configurationand the suture passer separated from the handle. In step 1, one handremoves a trocar from a wound. In step 2, the other hand inserts thehandle into the trocar wound until the catcher is completely visible ina laparoscope image. In step 3, one finger presses the control button toopen the catcher under visual guidance using the laparoscope image. Instep 4, one hand holds the handle and the other hand pushes the slidertoward the patient until the tissue to be sutured is firmly sandwichedbetween the slider and the catcher. The laparoscope image may be used toshow whether the catcher is in contact with the peritoneum wall. In step5, one hand holds the suture passer body and the other hand puts one endof suture into the hook of the suture passer. The finger then pressesthe needle button to load the suture passer. In step 6, one hand holdsthe handle and the other hand inserts the suture passer through theneedle track until the trigger is actuated, releasing (or deploying) thesuture on the catcher, again under the visual guidance of thelaparoscope image. In step 7, steps 5 and 6 are repeated with the otherend of the suture and the other needle track. In step 8, one fingerpresses the control button to capture the suture ends under visualguidance. In step 9, one hand pulls the handle from the wound andharvests from it the two suture ends.

FIG. 11 depicts an embodiment of struts from a suture catcher structurein a plan view and in cross-sections as part of an open and a closedsuture catcher structure. Suture catcher 1105 may contain a number ofstruts 1110. Each strut 1110 may have a proximal connection part 1115 toa proximal joint 1117 (an upper hinge), an upper strut 1120, a middlehinge 1125, a lower strut 1130, a distal (or lower) hinge 1135, and adistal connection part 1140 to distal hinge 1135. The hinges may beliving hinges, mechanical hinges, or metal wire/plate spring hinges. Thestruts may be made of metal (i.e. stainless steel), plastic (i.e.polypropylene, polycarbonate, polyurethane, nylon, or polyethylene) orany other suitable material. Multiple struts may be linked at theproximal joint as well as at the distal joint to form a catcher. Acontrol rod 1145 may be coupled to the distal connection part 1140 ofthe catcher and extended to the proximal end of suture delivery device.In one embodiment, motion of control rod 1145 drives the up and downmovement of distal connection part 1140 resulting in the opening (distaljoint up, or “deploying”) or the closing (distal joint down, or“retracting”) of the suture catcher. In an alternate embodiment, thecatcher deployment mechanism may be driven by controlling proximalconnection part 1115. In embodiments, when in the deployed configurationcatcher 1105 serves as a counterforce member to tissue-compressingforces.

The lengths of the lower and upper struts may be selected based on thedesired size of the target area of catcher 1105, or based on the desiredangle formed between the upper and lower struts, or both. The shape ofthe struts may be rectangular or trapezoid. An advantage of atrapezoidal shape over a rectangular shape is that a trapezoidal shapeprovides additional membrane packing space. The outer surface of thestruts (the surface visible in the retracted configuration) has manypossible variations including flat, flat with curved edges, or curved.Designs with curved surfaces may result in a suture delivery device witha more atraumatic outer profile, since there would be fewer sharp edges.That is, in the various embodiments, strut components (includingprotruding and matching features) may be flat or may be curved to createa more rounded exterior profile, see, e.g., FIG. 13C.

FIGS. 12A and 12B show embodiments of attaching a membrane 1200 to astrut 1205. Membrane 1200 may be made of materials such as polyurethane,PVC, polypropylene, or other pliable material that would not resistbeing punctured or folded too greatly. To retain a suture more reliablybetween struts during device withdrawal, the catcher should close sothat adjacent struts (or features for securing a suture, such as teeth)can engage in the designed manner. Proper closure of the catcher is muchmore likely if the membrane folds and packs into a profile that does notinterfere with catcher frame closure. But catcher membranes may notnaturally fold or pack in any particular direction or configuration. Inaddition, the space where the membrane may be packed is the spaceenclosed by the struts when they are contracted, and that space islimited. Furthermore, membranes with varying thickness and stiffnesshave different folding behaviors. The membrane attachment positionrelative to the strut has been found to impact its folding behavior.Thus, in embodiments, the struts or frame of the catcher may be designedto guide the membrane to fold in a desired manner, e.g., radially inwardtoward control rod 1245 (FIG. 12B).

The membrane may be coupled to the frame struts by various methods(e.g., adhesive, mechanical attachment, etc.). The membrane attachmentposition may be fully extended to the edge of the strut or may beattached in recessed position from the strut's lateral edges. Tofacilitate full enclosure of membrane by the strut upon catcher closure,membrane 1200 may be attached in recessed position 1210 from the lateraledges as shown in FIGS. 12A and 12B. Membrane 1200 typically has aminimum curvature and radius. Thus, attaching membrane 1200 recessedfrom the edge of strut 1205 allows for membrane 1200 to fold within thespace defined by the struts, as shown by fold 1215. This helps preventmembrane 1200 from clustering between struts 1205 and reducing theirability to clamp together and secure a suture.

FIGS. 13A-13D depict further embodiments for attaching a membrane to astrut. In FIG. 13A, strut 1300 has a two-piece construction, comprisingan outer (or top) strut component 1305 and an inner (or bottom) strutcomponent 1310 that combine to sandwich membrane 1315. The outer strutcomponent may be wider than the inner strut component and a membraneattachment edge 1320 may be recessed from the edges of the outercomponent 1305. The difference between outer and inner strut componentwidths provides membrane attachment support by sandwiching the membraneand facilitates membrane folding by allowing membrane attachment edge1320 to be recessed from the edge of strut 1305. In FIG. 13B, a membraneguiding feature 1325 may be used between strut 1305 and membrane 1315 tohelp push the membrane inward. Guiding feature 1325 may be a part ofstrut 1305, or membrane 1315, or a separate add-on component. Guidingfeature 1325 may be, for example, a metal rod. Guiding feature 1325protrude from the surface of the strut to increase or initiate thefolding of membrane 1315. Thus, instead of taking a path more inparallel with strut 1305, membrane 1315 bends immediately inwards tohelp achieve the intended membrane folding. Protruding features ofvarious shapes and sizes may be used to create different membranebending patterns as intended.

In FIG. 13C, outer strut component 1330 may have edges that curve inwardslightly to help facilitate membrane 1315 folding inward and away fromthe outer strut edges as the catcher closes. FIG. 13D depicts anembodiment of a catcher with a 2-piece strut design in a closedconfiguration. Closed catcher 1340 also has an outer strut component1345 with an angled edge 1350 that increases the contact surface betweenouter strut components 1345.

Generally, the membrane may be coupled to the catcher struts or frameusing various methods, such as adhesive, mechanical attachment, fusing,injection molding, or any other suitable means.

FIGS. 14A and 14B depict an embodiment for attaching a membranemechanically. In the embodiment, strut 1400 may have a two-piececonstruction with an outer/top strut component 1405 and an inner/bottomstrut component 1410 that sandwich membrane 1415. Membrane 1415 ispreferably pliable and may be secured by mechanical means, such asclamping or clasping. In this embodiment, outer strut component 1405 andinner strut component 1410 have interlocking features 1420 that assembletogether to secure membrane 1415. Interlocking features 1420 include aprotruding feature and a corresponding hole, which cooperate to fixmembrane 1415 between struts 1405, 1410. Membrane 1415 elongates andconforms around the protruding feature 1420. Positions 1430 indicate apossible pattern of features 1420. Alternately, membrane 1415 may haveholes punched that correspond to features 1420, so that membrane 1415does not elongate to conform to features 1420.

FIGS. 15A and 15B depict an embodiment for attaching a membranemechanically. In FIG. 15A, membrane 1505 has holes that allow thepassing of protruding feature 1520. Alternatively, the protrudingfeature may be designed to puncture through membrane 1505 during thestrut component interlocking process. A strut may contain multipleprotruding and matching features to form a desired securing pattern.

Membrane attachment to the strut may be provided solely by themechanical force produced by the interlocking components. Alternatively,adhesive may also be used to provide additional membrane attachmentforce. In embodiments where the protruding features are plastic and passthrough holes in the membrane, the protruding feature can be melted orwelded to the other strut component to provide an interlocking force.Additionally, the membrane may also be heat fused to one or both of thestrut components.

Metal has an advantage over plastic in resisting creep and it functionsmore effectively as a tension holding element. In an alternate to theembodiment of FIG. 15A, membrane 1505 may stretch over protrudingfeature 1520 while strut components with matching feature in the form of“metal clip” are applied to sandwich membrane 1505 to protruding feature1520. The metal clip part may be created by stamping or by any otherappropriate method.

FIG. 15B depicts an addition to the embodiment of FIG. 15A. The matchingfeature has the form of a thin metal part—a slide-lock 1525 with a slot1530. Slot 1530 is sized to slide onto the neck of protruding feature1520. In this variation, the membrane has punched out holes to admit theprotruding features. Slide-lock 1525 may be stamped or laser cut or madeby any other appropriate method.

FIG. 16 depicts an embodiment for attaching a membrane mechanically—bythreading it through a strut. Small slits 1605 may be created in asuture catcher strut 1610 and a membrane 1615 may be threaded throughthese openings. The size, length, and geometry of the openings may beoptimized to control the attachment of membrane 1615 to strut 1610.Membrane 1615 may be inserted through a first slit 1605 from theinterior side of strut 1610, traverse the exterior side of strut 1610,and then be inserted through the second slit 1605 to re-emerge on theinterior side of strut 1610. Additionally, adhesive or other methods maybe used as adjunct methods to increase the membrane-strut fixationforce. Slits 1605 also serve the purpose of guiding or controlling theangle at which membrane 1615 exits strut 1610. Slits 1605, since theyare positioned away from the lateral edges, result in membrane 1615emerging on the interior of the strut recessed some distance from thelateral edge. Membrane 1615 is therefore less likely to interfere withstrut closure as it has room to turn radially inward and is alreadyguided in that direction by the slits 1605.

In an alternate embodiment, slits 1605 may extend to one end of strut1605, creating openings for membrane 1615 to be slid into and beretained by strut 1610 (akin to a paper clip). The opened edge may be onthe outer radial edge or on the inner edge in proximity to the deviceshaft.

A membrane stretched between two struts has a tendency to sag along theunsupported edges. In embodiments, membranes may sag, particularly wherethey extend radially beyond a direct line between two struts ends. Insuch sections the membrane does not have sufficient support from thestruts, and may not be stiff enough itself to resist bending away whencontacted by a needle or suture passer. Such bending may reduce theeffective target zone for suture capture, since the needle may slidepast the bending membrane instead of penetrating it. Embodiments aredirected to managing the extent the membrane may sag or bend, many byimproving membrane tautness.

FIG. 17 depicts an embodiment of a catcher for managing the extent themembrane may sag or bend. In FIG. 17, membranes 1705 have straight-lineedges 1710 that follow a line between the external radial edges of twoadjacent, opened struts 1715. Membranes 1705 may be more effective incapturing sutures than shapes where membrane material extends beyond theline between strut ends (e.g., membranes with extended arc shaped outeredges). Straight-line shaped membranes 1705 eliminate membrane areasthat are not well-supported by struts 1715 and thereby reduce thelikelihood of membrane 1705 bending upon needle contact. Thus, membranes1705 maximize the effective suture capture area.

In an alternate embodiment, the membrane may be any shape, ornon-existent, between struts where suture capture is not intended, i.e.,where needle tracks are not directed.

In embodiments, the edge of membrane 1705 may be reinforced with atension element 1720 that improve membrane tautness. In one embodiment,tension element 1720 may be a string or other fiber coupled to the edgeof the membrane with its ends attached to the catcher struts, much likethe string around the periphery of a kite. For example, tension element1720 may be a Kevlar fiber fused at the edge of the membrane. The fibermay be stretched to create tension in the fiber section between thestrut ends and thereby provide support to the outer edge of themembrane. A mechanism for tensioning the fiber may be the deployment ofthe catcher struts. An alternate or additional mechanism for tensioningthe fiber may be to cause the struts to extend radially outward afterthe catcher struts have been deployed.

The fiber may be coupled to the membrane edge by different methods. Onemethod is to glue the fiber to the edge of the membrane. Another methodis to fold the membrane edge to create a pocket to contain the fiber.Yet another method is to fuse membrane layers together with the fiberembedded between the layers.

The tension element may be more pliable than the membrane so that thetension element does not adversely impact membrane packing. Inembodiments, the tension element itself may have a default bend thatassists the folding of the membrane. The cross-section of a tensionelement may be of any desired shape.

FIGS. 18A and 18B depict an embodiment of a suture delivery devicehandle 1800. In embodiments, suture ends 1805, 1810 may be loaded ontohandle 1800 before handle 1800 is inserted into inserting into thesurgical opening. In FIG. 18A, suture ends 1805, 1810 have been loadedonto handle 1800 at the distal openings 152, 157 of needle tracks 150,155. FIG. 18B depicts a friction method of loading a suture. In FIG.18B, slots 1815, 1820 are configured to retain suture ends 1805, 1810,by, for example, a press-fit or other wedging action. In an alternateembodiment, flexible retaining flaps 1825, 1830 are added to furtherretain suture ends 1805, 1810. Flaps 1825, 1830 may be, for example,rubber or metal depending on the retention force desired. Furthermore,handle 1800 may have suture ends 1805, 1810 loaded during the factoryassembly process.

FIGS. 19A and 19B depict an embodiment for loading a suture using asuture cassette. In FIG. 19A, a cassette 1905 stores one suture 1910 andhas two access ports providing access to suture ends 1915 1920. In FIG.19B, handle 1900 has a cassette insert port 1925 configured to receivesuture cassette 1905 and position exposed suture ends 1915, 1920 withinneedle tracks 150, 155 internally within handle 1900 for eventualloading onto a suture passer in preparation for deploying the sutures.

In an embodiment, slider 115 is spring-loaded to compress the tissue tobe sutured upon pressing control button 130. Thus, in the embodiment,pressing control button 130 may cause two actions. First, catcher 110may be deployed, and second, slider 115 may be forced to movedistally—toward catcher 115. These actions may be accomplished with aspring that is loaded as the slider moves proximally—away from catcher110. The spring may have a trigger that is actuated by the final stageof the button stroke so that pressing control button 130 first openscatcher 110 and, as control button 130 is pressed an arbitrary furtheramount, the trigger actuates to release the spring, which then pushesslider 115 against the skin, sandwiching the tissue between slider 115and catcher 110.

FIGS. 20A-20C depict an embodiment in which wings are flexible sectionsof catcher struts and assist with capturing a suture. FIG. 20A depictsstruts 912, 914, 916, 918 with sections similar in dimension andstiffness to struts 112, 114, 312, 314 (FIG. 3). Struts 912, 914, 916,918 have flexible wings 1905, 1910, 1915, 1920. FIG. 20B depictsflexible wings 1905, 1910 being folded within catcher 110 as it isretracted. When catcher 110 is deployed, wings 1905, 1910, 1915, 1920open to their intended positions, and wing pairs 912, 916 and 914, 918open and overlap, presenting a target area for a suture as in FIG. 20A.In the embodiment, the target area presented by the overlapping wingpairs is a plane similar to that presented by membranes 302, 305 (FIG.3), yet 1905, 1910, 1915, 1920 do not rely on tension for support and,thus, they may be configured to extend beyond an area defined by struts912, 914, 916, 918. Wings 1905, 1910, 1915, 1920 may assist capturing asuture end by being punctured, similarly to membranes 302, 305, or theymay assist capturing a suture by allowing suture passer 200 to passthrough seams 1925, 1930 between the wing pairs. Once suture passer 200passes through seams 1925, 1930, releases the suture, and is withdrawn,the wing pair 1905, 1915 or 1910, 1920 closes about and captures thedeployed suture. The captured suture ends may then be drawn in by thewing pair when catcher 110 is retracted (FIG. 20C) and more firmlygrasped by the strut pair 912, 916 or 914, 918.

FIGS. 21A-21E depict embodiments allowing multiple uses of a catchermembrane by varying the location that a catcher membrane is penetrated.Generally, each insertion of needle through a membrane creates andleaves a footprint on the membrane. With multiple needle insertion, theholes created in the membrane may reduce the membrane's ability tocapture and retain subsequent sutures. Embodiments provide for multipleuses of the same device by changing the area penetrated by the suturepasser for each use. The suture catcher may be rotated so that theintended membrane area for needle penetration is (sufficiently)different every time. The rotation may be large angle or small angledepending on the intended number of needle penetrations and allowablerepeated needle penetrations. Other embodiments reduce the probabilityof a needle penetrating in the same area repeatedly by, e.g., providinga random rotation of the suture catcher.

FIGS. 21A and 21B depict an embodiment of a multi-use catcher with arandom rotation mechanism. In this embodiment, the struts of the catchermay pivot within a defined distance relative to the handle shaft. Amembrane attached to the struts may pivot with them. In FIG. 21A, asingle strut 2010 is pictured for clarity, but the following descriptionapplies to the other struts of a catcher. Catcher strut 2010 is free topivot about an angle 2015 within a window 2020 in shaft 2005. The sizeof window 2020 may define how much catcher strut 2010 can rotate. Window2020 may be provided in a proximal part (e.g., proximal connection part1115 (FIG. 11) for each strut of a catcher, allowing each individualstrut to move freely within the windows. The connection between thedistal joint and the control rod may be floating such that rotation ofthe proximal joint will result in rotation of the whole catcher. Therandom rotation of the catcher allowed in this embodiment reduces theprobability that two needles will penetrate the membrane precisely atthe same location. FIG. 21B depicts a puncture pattern on a membranethat may result from the rotation of a catcher equipped with struts asin FIG. 21A. In FIG. 21B, membrane 2025 shows punctures 2030 a, 2030 b,2030 c that may result from the use of suture passer within a singleneedle track, e.g., needle track 155 (FIG. 3), as the catcher andmembrane are rotated within angle 2015.

FIG. 21C depicts an embodiment of a multi-use catcher with a needletrack with an internal pivot point. Needle track 2105 may be greater indiameter than a needle or suture passer between insertion point 2110 anda narrowing 2120 and between an exit point 2115 and the narrowing 2120.Narrowing 2120 may be a constriction of needle track 2105, or simply abump, at some position within needle track 2105 that functions as apivot point. With the needle or suture passer being able to moveradially within needle track 2105, narrowing 2120 may function as apivot point to facilitate moving the distal end of the needle or suturepasser with respect to the surface of a suture catcher 2135 by movingthe proximal end of the needle or suture passer, as depicted byexemplary suture passer positions 2125, 2130. Suture passer positions2125, 2130 show that, per the embodiment, a suture passer may exitneedle track 2105 at various angles relative to shaft 2140 and suturecatcher 2135. The changing angles reduce the probability that the needlewill penetrate a membrane on suture catcher 2135 at precisely at thesame location. In an embodiment, needle track 2105 may be hourglassshaped. In a further embodiment, needle track 2105 may not havenarrowing 2120, but still allow for exemplary suture passer positions2125, 2130 by being generally larger in diameter than the needle orsuture passer.

FIG. 21D depicts a top view of a handle 2200 that provides for multipleuses of a catcher membrane. In FIG. 21D, multiple needle track pairs2205 a and b, 2210 a and b, and 2215 a and b, each target differentrespective areas (not shown) of a membrane. In addition, a dial feature(not shown) may rotate atop handle 2200 to expose one set of needletracks at a time.

FIG. 21E depicts a cross-section of a multi-use embodiment employing anautomatic pen rotation mechanism. Rotation of the suture catcher mayensure that a needle or suture passer penetrates a membrane at an unusedlocation of the membrane. In the embodiment, an automatic pen rotationmechanism 2300, or a variation, may be used to achieve this. Mechanism2300 contains features that transfer up and down movement of control rod2305 into a rotational movement of control rod 2305. With control rod2305 connected to the distal joint of the suture catcher so thatrotation of control rod 2305 results in rotation of the distal joint,and with the proximal joint of the suture catcher allowing rotationalmovement of the suture catcher, the rotation of control rod 2305 willresult in the rotation of the suture catcher. The magnitude of theresulting rotation is controlled per the design of rotation mechanism2300 and may be arbitrarily small or large. In a variation of thisembodiment, the up and down movement of control rod 2305 results in arotational movement of the proximal joint of the suture catcher, theconnection between the distal joint and the control rod is floating, andthe rotation of the proximal joint results in the rotation of the wholesuture catcher.

Embodiments may employ a suture passer with a tip designed to receivesutures that are pre-loaded on the handle (see, e.g., FIGS. 18A and 18Band related text regarding loading sutures on the handle). In suchembodiments, the tip of the suture passer preferably is able to: graspthe suture ends before entering the abdominal tissues; retain the sutureends while penetrating the tissue to be sutured and a catcher membrane,if the catcher is so equipped; and deploy the suture ends.

FIGS. 22A-22D depict different embodiments of suture passers designed tograsp, retain, and deploy a suture. In FIG. 22A, suture passer 2400 hasa fixed tip 2405 with a slot 2410 configured to engage a suture 2415positioned at an exit 2420 of a needle track 2425. In FIG. 22B, suturepasser 2430 has an actuated tip 2435 with a clamping member 2440 forclamping a suture 2445 against a fixed member 2450 at the urging of anapparatus 2455, e.g., a driving axle, internal to suture passer 2430. InFIG. 22C, suture passer 2460 has a grasping tip 2465 with a needle head2470 actuated by an internal rod 2475 for grasping a suture 2480 againsta needle tube 2485. FIG. 22D depicts the grasping tip of suture passer200 previously described with reference to FIGS. 2A and 2B forcomparison. This embodiment of a suture passer may also be used toreceive sutures that are pre-loaded on the handle. Similarly, theembodiments of suture passers in FIGS. 22A-22C may be loaded with asuture before being inserted into a needle track of a handle. Inembodiments, any of the needle tip embodiments disclosed may beconfigured to cooperate with any of the needle tracks disclosed.

In an embodiment of a procedure for deploying a suture loaded on ahandle, after the tissue to be sutured is sandwiched by a handle (see,e.g., FIG. 8B), the suture passer is inserted into and through theneedle track until the tip reaches the suture loaded on the handle. Thesuture is then loaded onto the suture passer. Then the suture passer isinserted through the needle track to deploy the suture end on thecatcher. Depending on the catcher configuration, the suture end may bedeployed by being released within grasping distance of catcher struts,or may be deployed by being inserted into a catcher membrane and thenreleased. After the suture is released, the suture passer may bewithdrawn and inserted into a second needle track with the aboveprocedure repeated with a second suture loaded on the handle.

FIGS. 23A and 23B depict a cross-section of an embodiment in whichsuture passers are integrated into a handle 2500. In FIG. 23A suturepassers 2505, 2510 are situated within needle tracks 2515, 2520,respectively, and used to deploy sutures. Suture passers 2505, 2510 maybe designed to reside within needle tracks 2515, 2520. Control button2540 (or control lever, or control slider) may, upon actuation, causesuture passers 2505, 2510 to travel through needle tracks 2515, 2520,grasp the loaded sutures, extend from shaft 105 of handle 2500, andpenetrate the tissue to be sutured, e.g., the abdominal tissues. Suturepassers 2505, 2510 may then deploy the suture onto catcher 110.

In the embodiment, suture passers 2505, 2510 may be deployed using aroller and track 2545 and control button 2540 to advance the two suturepassers through needle tracks 2515, 2520 to deploy the sutures. Rollerand track 2545 may include rollers 2550 within a track 2555 connected toactuating arms 2560. Control button 2540 when pressed may cause rollerand track 2545 and actuating arms 2560 to travel toward a distal end2525 of handle 2500. Actuating arms 2560 then force suture passers 2505,2510 through needle tracks 2515, 2520 to deploy the sutures. Roller andtrack 2545 are configured to allow actuating arms 2560 to move inwardlywithin handle 2500 as arms 2560 travel in the distal direction. In FIG.23B, control button 2540 has been completely depressed, forcing suturepassers 2505, 2510 to extend past catcher 110, open suture passer tips(see, e.g., FIGS. 22B-D), and deposit the sutures (not shown). Themotion of control button 2540 has revealed control button 130, which asdescribed earlier controls catcher 110 and perhaps also slider 115. Themotion has also caused rollers 2550 to move inwardly within track 2555in response to actuating arms 2560 following the contour of needletracks 2515, 2520. In an embodiment, the functions of control buttons130 and 2540 are performed by a single control button.

The embodiments of the suture delivery devices may be used to practicethe methods for inserting and withdrawing a suture passer, and forcapturing, retaining, and securing a suture. In embodiments, membraneproperties influence capturing, retaining, and securing a suture. Asdescribed, when a needle or suture passer carrying a suture is insertedthrough a membrane, a suture may be released and captured by themembrane. When the catcher is then closed, the membrane may fold withthe catcher frame closure, retaining the suture within the membrane. Themembrane itself may be made of a material with a high coefficient offriction or further having designs that increase the suture-retainingproperties of the membrane. The retentive property may be a function ofthe material thickness, or of the number of material layers, or of thematerial surface. The retentive property may be on either or both sidesof the retaining surface.

In embodiments, a suture may be secured by catcher strut edges. A numberof methods may be employed (separately or in combination) to ensure thata suture is secured to the distal end of the device. Mechanical clampingof the suture may be used to retain the suture during the withdrawal ofthe suture delivery device from the surgical opening. Edges of adjacentstruts may be used to hold a suture securely (as a mechanical clamp).For embodiments in which a suture catcher is equipped with a membrane,the membrane retention force may not be sufficient to withstand theforce exerted by the sutured tissue on the suture, even if the suture isproperly engaged with the membrane. Thus, adjacent catcher struts may beused as a clamp to secure a suture. Such adjacent struts may be usedindependently (e.g., in catcher embodiments that do not include amembrane), or may be used in combination with a membrane (e.g., incatcher embodiments that include a membrane).

FIGS. 24A-24E depict embodiments of catchers that vary the length of aclamping surface, or the number of clamping surfaces, or number ofcontact points. In FIG. 24A, strut edges 2605, 2610 of struts 2620 havebeen angled to increase the contact surface with suture 2615. That is,the edges of catcher frame struts have been beveled and the suture is incontact with the strut for the length of the beveled edges. In FIG. 24B,struts 2625, 2630 are configured to create a single contact point 2635against suture 2615. In FIG. 24C, struts 2640 are sized differently fromstruts 2650. Suture 2615 is clamped between the surfaces of a pair ofdifferently sized struts 2640, 2650. In FIG. 24D, strut edges 2655, 2660engage, creating an angle in suture contact surface 2665. The angle maybe, e.g., 90 degrees. The catcher struts may also have saw tooth or wavyedges along the suture contacting edges. The advantage of designs withsuch edges is that the direction of the force applied to the suture ischanged, increasing the normal force at points along the suture. In FIG.24E, struts 2670 are added to the configuration of FIG. 24B, creatingadditional suture contact points 2637.

In embodiments, in addition to various strut designs just discussed, thestrut edges may be roughened, treated, coated, or otherwise processed toincrease friction and enhance suture-securing performance. For example,rubber pads or strips, or a rubber coating may be applied to the strutedges.

In alternate embodiments of a catcher, the suture may be clamped betweena catcher strut folding inwardly against the control rod, or against ablock positioned about the control rod that presents a flat surface tothe strut as the strut folds inward. In such embodiments, both themembrane and the suture may be clamped between an exterior element (thestrut) and an interior element (either the control rod, or the blockabout the control rod). Since the effectiveness of clamping a suture maybe associated with the sufficient (or complete) closure of the suturecatcher, the level of the applied closing force and any interferencecaused by the membrane may affect clamping effectiveness.

In the various embodiments of a suture catcher, increasing the strutclosing force may increase the retaining force on the suture. As aresult, the catcher may retain the suture during a more forcibleextraction of the suture delivery device from a surgical opening.

In embodiments, the suture may be retained by the catcher without acapture surface, e.g., a membrane. In such embodiments, the struts ofthe catcher may directly clamp the suture. The clamping action may, forexample, be a part of the catcher being retracted for extraction fromthe surgical opening.

FIGS. 25-27 depict further embodiments for delivering and catching asuture. FIGS. 25A, 25B, and 26 depict embodiments for capturing a sutureon one side of a surgical opening and moving the suture to the otherside for completing the suture. FIGS. 25A and 25B depict top andperspective views, respectively, of a clamping apparatus 2700 withclamping arms 2705, 2710 that pivot in directions 2707, 2712,respectively, to capture a suture end 2720. Clamping arm 2705 may berotated by inner shaft 2725 and clamping arm 2710 may be rotated byouter shaft 2730. Clamping apparatus 2700 may be substituted for catcher110 on handle 100 of, e.g., FIGS. 1A and 1B. Clamping apparatus 2700 maybe used to capture suture 2720 and position on an opposite side ofclamping apparatus 2700 within a surgical opening.

FIG. 26 depicts a perspective view of a capture apparatus 2800 with alarge area membrane 2805 supported by struts 2810 that pivot about ashaft 2815 to deposit a captured suture 2820 on an opposite side ofcapture apparatus 2800. Suture 2820 may be captured by membrane 2805 asdiscussed previously. Capture apparatus 2800 may also be substituted forcatcher 110 on handle 100 of; e.g., FIGS. 1A and 1B.

An embodiment may include an umbrella-shaped membrane, where themembrane is supported by several radially expanding struts and spans 360degrees around the device. Like an umbrella, the membrane may be intension, making it easier for a needle to penetrate the membranematerial. Also, the friction between the membrane material and thesuture may be enough to disengage and retain the suture as the suturepasser is withdrawn. Alternate embodiments may include multi-layermembranes where each layer has different orientation. In such amulti-layer membrane, the suture may be disengaged from the suturepasser due to both friction and becoming entangled in the latticestructure.

The embodiments depicted by FIGS. 25A, 25B, and 26, may be usedaccording to the following method. The needle (or suture passer)carrying a suture is inserted into a needle track and then into themuscle/fascia layers on one-side of trocar wound using a handle equippedwith either clamping apparatus 2700 or capture apparatus 2800. Thesuture passer releases the suture and is withdrawn. For clampingapparatus 2700, the suture is then captured by the motion of clampingarms 2705, 2710. For capture apparatus 2800, the suture has penetratedmembrane 2805, which has material properties or designs to disengage thesuture from the needle passer and retain it. Once the suture isretained, the suture may be moved by rotating apparatus 2700 or 2800causing suture 2720 or 2820 to be repositioned to the opposite side ofthe trocar wound. The surgeon may then easily retrieve the suture, sincethe suture is positioned at the target point of a needle (or suturepasser) inserted through the other needle track of the handle andthrough the tissue to be sutured. Once through the tissue to be suturedthe needle (or suture passer) may capture the repositioned suture withguidance from a laparoscopic image. The captured suture may have acontrolled shape, orientation, and tension that would facilitate thesurgeon retrieving it. These embodiments, like previous embodiments,remove the need for an assistant to help move the suture to where thesurgeon can grasp the suture with suture passer.

FIG. 27 depicts a top view of an embodiment for linking suture endswithin a surgical opening. In FIG. 27, clamping apparatus 2900 hasclamping arms 2905, 2910 that pivot in directions 2907, 2912,respectively, to sweep through an arc and capture suture ends 2920,2922. Clamping arm 2905 may be rotated by inner shaft 2925 and clampingarm 2910 may be rotated by outer shaft 2930 (alternately, only oneclamping arm is rotated to capture both suture ends). Clamping apparatus2900 may be substituted for catcher 110 on handle 100 of, e.g., FIGS. 1Aand 1B. Clamping apparatus 2900 may be used to capture suture ends 2920,2922 and link them together with a link element 2935. Link element 2935may be a crimp or biodegradable member affixed to one of clamping arms2905, 2910. It may also be a clamp or clip. Additionally, suture ends2920, 2922 may be linked using adhesive or heat, etc. The resultingsuture linkage should be at least strong enough to sustain pulling thesuture joint through the tissue track created by the needle or suturepasser. Alternately, the suture linkage should be strong enough toprovide wound closure.

Clamping apparatus 2900 may be used according to the following method.The sweepers or clamp arms are initially positioned not to interferewith suture delivery. Two suture ends are delivered on opposite sides ofa trocar wound. The clamp arms are then rotated to bring the suture endsinto contact with the link element. The suture ends and the link elementare then pressed together by the clamp arms to link the suture. Thesuture delivery device may then be withdrawn.

With this embodiment, one option for finishing a suture involvesdelivering two ends of one suture. Once the two sutures ends are linked,the linked suture becomes a loop. The user may cut the suture at theproximal end—outside of the trocar wound. Then the user may pull theexternal suture ends to close the wound, and then knot the ends.Alternatively, the user could pull the suture link out through thesurgical opening with the suture delivery device, or tug on one side ofthe suture loop to bring the link out through the tissue track createdby the initial needle insertion. The user may then cut the suture joint,close the surgical opening and tie the knot. Another option is todeliver two suture ends into the abdomen, each end from a separatesuture. Once the two sutures ends are linked, the user could withdrawthe device and finish the suture as described above.

In an embodiment, a catcher closure mechanism is slider activated. Asuture delivery device may have a sliding member, which can bepositioned to sandwich abdominal wall tissue against a counterforcemember (e.g., a catcher), in the abdominal cavity. Many of theembodiments described are configured this way. In this embodiment, thesliding member may be coupled to the catcher deployment mechanism sothat movement of sliding member may be used to control the catcheropening and closing. With the sliding member coupled to the deploymentmechanism, as the sliding member moves downward (towards the distal endof device), the catcher deployment mechanism may be actuated to open thecatcher. When the sliding member moves upward (towards the proximal endof the device), the catcher deployment mechanism may be actuated toclose the catcher. The position where the sliding member interacts withthe catcher deployment mechanism may be designed as desired. In oneembodiment, the catcher may be opened when the sliding member travels asmall distance downward while the catcher may be closed when the slidingmember travels a small distance upward. For example, moving the sliderdownwards may cause the distal joint to move upwards and thereby deploythe suture catcher. Various mechanism options may be used to enable thisconcept.

A method for using an embodiment may include: inserting a suturedelivery device through a tissue track until a distal end is inside acavity; moving a sliding member towards a device distal end to open acatcher and then sandwich the abdominal wall tissue between the catcherand the sliding member; delivering a suture to the suture retentionelement (catcher) by inserting a suture-carrying needle into the deviceuntil suture is released and retained at the distal end (or until thesuture is released and captured by the catcher); moving the slidingmember towards the proximal end of device to close the catcher andrelease the abdominal wall tissue; and withdrawing the suture deliverydevice from the cavity with the suture ends retained at the device'sdistal end.

A method for automatically deploying a suture may include: inserting asuture delivery device into a surgical opening; sandwiching the woundtissue; deploying the suture ends, and withdrawing the handle.Sandwiching the wound tissue may further include: pressing a button thatcauses the catcher to open and the slider to compress the tissue againstthe catcher. Deploying the suture ends may further include: using anindependent suture passer, or using a suture passer that is integratedwith the handle. Withdrawing the handle may further include: closing thecatcher to capture sutures, and an automatic suture release.

A method for deploying a suture may include: loading a suture onto ahandle, or loading a suture cassette into a handle; with a left hand,removing a trocar; with a right hand, inserting the handle into thetrocar wound until the catcher is completely visible from a laparoscopeimage; with the right hand, releasing a control button that opens thecatcher and then pushes the slider down to sandwich the tissue undervisual guidance. The laparoscope image may be used to show whether thecatcher is in contact with the peritoneum wall. In an embodiment, thismethod for deploying a suture optionally includes: with the left hand,holding the handle; with the right hand, inserting the suture passerthrough the needle track to deploy suture on the catcher under visualguidance; and repeating this with the other needle track under visualguidance. In another embodiment, this method for deploying a sutureoptionally includes: using the left hand, holding the handle; using theright hand, pushing a deployment button to deploy a suture on thecatcher under visual guidance; using the left thumb, pressing thecontrol button to capture the sutures under visual guidance; and usingthe left hand, pulling out the handle and harvesting the two sutureends.

Described herein are certain exemplary embodiments. However, one skilledin the art that pertains to the present embodiments will understand thatthe principles of this disclosure can be extended easily withappropriate modifications to other applications.

What is claimed is:
 1. A suture delivery device for suturing tissuecomprising: an elongated deployment member; a counterforce memberdisposed towards a distal end of the elongated deployment member,wherein the counterforce member is configured to transition between aretracted configuration that facilitates the counterforce memberentering an incision and a deployed configuration that resistsextracting the counterforce member from an incision; a compressionmember disposed towards a proximal end of the elongated deploymentmember with respect to the counterforce member, wherein the compressionmember is configured to resist entering an incision, and wherein thecompression member and the counterforce member transition between acompressed configuration and an uncompressed configuration; a suturecatcher disposed towards the distal end of the elongated deploymentmember, wherein the suture catcher is configured to transition between aretracted configuration that facilitates the suture catcher entering anincision and a deployed configuration that facilitates catching asuture; a first needle track associated with the elongated deploymentmember and oriented towards a first area of the suture catcher when inthe deployed configuration; and a second needle track associated withthe elongated deployment member and oriented towards a second area ofthe suture catcher when in the deployed configuration, wherein the firstarea of the suture catcher when in the deployed configuration and thesecond area of the suture catcher when in the deployed configuration aresituated on the suture catcher to allow their placement on oppositesides of an incision.
 2. The suture delivery device of claim 1, whereinin the compressed configuration the compression member is at a firstdistance from the counterforce member and in the uncompressedconfiguration the compression member is at a second distance from thecounterforce member, the first distance being less than the seconddistance.
 3. The suture delivery device of claim 2, wherein thecompression member is moved in transitioning between the compressedconfiguration and the uncompressed configuration.
 4. The suture deliverydevice of claim 2, wherein the counterforce member is moved intransitioning between the compressed configuration and the uncompressedconfiguration.
 5. The suture delivery device of claim 1, wherein thesuture catcher comprises a membrane that retains a suture inserted intoor through the membrane.
 6. The suture delivery device of claim 1,wherein the suture catcher comprises struts configured to close about asuture, and wherein the first area of the deployed suture catchercomprises a first area between the struts and the second area of thedeployed suture catcher comprises a second area between the struts. 7.The suture delivery device of claim 6, wherein the struts are providedwith teeth that engage the suture upon the strut closing about thesuture.
 8. The suture delivery device of claim 6, wherein the suturecatcher further comprises a membrane, the membrane and the struts beingconfigured to position the membrane in the first and second areasbetween the struts, the membrane retaining a suture inserted into orthrough the membrane.
 9. The suture delivery device of claim 1, whereinthe suture catcher comprises struts, each strut with an attachedflexible wing, wherein the first area of the deployed suture catchercomprises a first area between a first strut and a second strut, and thesecond area of the deployed suture catcher comprises a second areabetween a third strut and a fourth strut, wherein when the suturecatcher is deployed the wings of the first and second struts unfold toposition themselves in the first area between the struts and the wingsof the third and fourth struts unfold to position themselves in thesecond area between the struts, wherein the wings in the first area areconfigured to retain a suture between them and the wings in the secondarea are configured to retain a suture between them, and wherein thefirst and second struts are configured to close about a suture retainedby the wings of the first and second struts and the third and fourthstruts are configured to close about a suture retained by the wings ofthe third and fourth struts.
 10. The suture delivery device of claim 1,wherein the first and second needle tracks are integrated into theelongated deployment member and exit the elongated deployment memberproximally from the counterforce member.
 11. The suture delivery deviceof claim 10, wherein the first and second needle tracks are joined by asuture exit slot configured to allow a suture loop to exit the device.12. The suture delivery device of claim 1, wherein: the compressionmember is configured to move axially along the elongated deploymentmember in transitioning between the uncompressed and compressedconfigurations, the first and second needle tracks each pass throughboth the compression member and the elongated deployment member, thefirst and second needle tracks comprise respective first and secondpairs of telescoping tubes, a first tube of each telescoping pairanchored at the compression member and a second tube of each telescopingpair anchored at the elongated deployment member, the anchors allowingfor angular changes, motion of the compression member along theelongated deployment member results in the telescoping pairs of tubesvarying an angle of the first needle track with respect to the elongateddeployment member and an angle of the second needle track with respectto the elongated deployment member, the varying of the angles betweenthe first and second needle tracks and the elongated deployment memberresulting in varying the first and second areas of the suture catcher.13. The suture delivery device of claim 1, further comprising a suturepasser, the suture passer comprising: a needle tube dimensioned to beaccepted within the first or second needle track; a shaft disposedwithin the needle tube, the shaft having a ramp on a distal end, theramp, shaft, and needle tube configured to retain a suture when the rampis at least partially covered by the needle tube and to release a suturewhen the ramp is not covered by the needle tube; and a trigger, thetrigger causing, when moved in a proximal direction, the ramp to beuncovered, wherein the first and second needle tracks, needle tube,shaft, and trigger are configured to uncover the ramp when the suturepasser is inserted a pre-determined distance into the first or thesecond needle track, and wherein the pre-determined distance positionsthe suture for capture by the suture catcher.
 14. The suture deliverydevice of claim 1 wherein the first needle track and the second needletrack each have a constriction between their proximal and distal ends,the constriction providing a point about which a suture passer in thefirst or second needle track may pivot and thereby vary the locations ofthe first and second areas of the suture catcher when in the deployedconfiguration.
 15. The suture delivery device of claim 1 furthercomprising: a suture cassette provisioned with at least one suture; anda suture cassette port intersecting the first and the second needletracks, wherein the suture cassette and the suture cassette port areconfigured to position a first suture end within the first needle trackand a second suture end within the second needle track.
 16. The suturedelivery device of claim 1, further comprising: a third needle trackassociated with the elongated deployment member and disposed to direct athird suture end towards a third area of the suture catcher when in thedeployed configuration; and a fourth needle track associated with theelongated deployment member and disposed to direct a fourth suture endtowards a fourth area of the suture catcher when in the deployedconfiguration, wherein the third area of the suture catcher when in thedeployed configuration and the fourth area of the suture catcher when inthe deployed configuration are situated on the suture catcher to allowtheir placement on opposite sides of an incision.
 17. The suturedelivery device of claim 16, further comprising a dial configured toallow access to either the first and second needle tracks, or the thirdand fourth needle tracks.
 18. The suture delivery device of claim 1,further comprising: a first suture passer within the first needle track;a second suture passer within the second needle track; and a deploymentbutton, wherein the deployment button is configured to advance the firstand second suture passers through the first and second needle tracks,respectively.
 19. A suture delivery device for suturing tissuecomprising: an elongated deployment member; a counterforce memberdisposed towards a distal end of the elongated deployment member,wherein the counterforce member is configured to transition between aretracted configuration that facilitates the counterforce memberentering an incision and a deployed configuration that resistsextracting the counterforce member from an incision; a compressionmember disposed towards a proximal end of the elongated deploymentmember with respect to the counterforce member, wherein the compressionmember is configured to resist entering an incision, and wherein thecompression member is positionable along the elongated deployment memberto transition between a compressed configuration and an uncompressedconfiguration; a suture catcher disposed at the distal end of theelongated deployment member, wherein the suture catcher is configured totransition between a retracted configuration that facilitates the suturecatcher entering an incision and a deployed configuration thatfacilitates catching a suture; a first needle track associated with theelongated deployment member and oriented towards a first area of thesuture catcher when in the deployed configuration; and a second needletrack associated with the elongated deployment member and orientedtowards a second area of the suture catcher when in the deployedconfiguration, wherein the first area of the suture catcher when in thedeployed configuration and the second area of the suture catcher when inthe deployed configuration are situated on the suture catcher to allowtheir placement on opposite sides of an incision.
 20. A suture deliverydevice for suturing tissue comprising: an elongated deployment member; acounterforce member disposed towards a distal end of the elongateddeployment member, wherein the counterforce member is configured totransition between a retracted configuration that facilitates thecounterforce member entering an incision and a deployed configurationthat resists extracting the counterforce member from an incision, andwherein the counterforce member includes a suture catcher; a compressionmember disposed towards a proximal end of the elongated deploymentmember with respect to the counterforce member, wherein the compressionmember is configured to resist entering an incision, and wherein thecompression member is positionable along the elongated deployment memberto transition between a compressed configuration and an uncompressedconfiguration; a first needle track associated with the elongateddeployment member and oriented towards a first area of the suturecatcher when in the deployed configuration; and a second needle trackassociated with the elongated deployment member and oriented towards asecond area of the suture catcher when in the deployed configuration,wherein the first area of the suture catcher when in the deployedconfiguration and the second area of the suture catcher when in thedeployed configuration are situated on the suture catcher to allow theirplacement on opposite sides of an incision.